Asking the Community About Cutpoints Used to Describe Mild, Moderate, and Severe Pain

Palos, Guadalupe R.; Mendoza, Tito R.; Mobley, Gary M.; Cantor, Scott B.; Cleeland, Charles S.

doi:10.1016/j.jpain.2005.07.012

Cited by 104 publications

(79 citation statements)

References 17 publications

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“…A significant difference in VAS measurements seems to be around 20 units [16,27] and four categories of pain intensity seem logical to the majority [31]. Differences in pain reporting according to ethnicity, gender and age have been shown previously [3,34].…”

Section: Discussionmentioning

confidence: 89%

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Löfvander

Taloyan

2007

Eur Spine J

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The aim of this study was to explore if self-rated pain intensity and severe pain differed significantly between immigrants from different regions, and if other socio-economic, or clinical, characteristics could predict severe pain. A total of 129 men and 217 women at a primary health centre in Stockholm, Sweden, 27-45 years, on long-term sick leave, were recruited in consecutive order and grouped into a Turkish (n = 122), Southern European (n = 52), Middle East (n = 69) and one Mixed (n = 173) group of immigrants. All were employed in service jobs. Somatic status, depression and level of psychosocial stressors, including pain anxiety, were established by standardized procedures. All reported long-standing disabling back pain. Patients rated intensity of pain ''right now'' on a 0-100 mm visual analogue scale (VAS) as a last part of the consultation with two doctors. Severe pain was defined as VAS 75-100. Median values (md) with inter-quartile ranges (IQR) were calculated for interval and ordinal data. Non-parametric statistics were used to calculate significant differences between groups. Crude and age-standardized odds ratios (OR) with 95% confidence intervals (95% CI) as rating severe pain were calculated by binary and forward conditional logistic regression. Men and women were analyzed separately. Women had more tender points, (P \ 0.001), and reported pain anxiety more often (P \ 0.01). Frequency of depression did not differ between the immigrant groups. The VAS-values varied, but not significantly, between the immigrant groups of men and women. Men had lower VAS values than women (md 50, IQR 36-69 vs. md 72, IQR 51-85), (P \ 0.001). Women had a three-fold risk to rate severe pain (OR 2.9, 95% CI 1.8-4.7). By sex, no immigrant group had significantly elevated OR to rate severe pain. Being 40-45 year old doubled the OR as rating severe pain. Men with depression, or little education, had high risks as rating severe pain (age-standardized ORs 4.1; 95% CI 1.7-10.0 and 2.7; 95% CI 1.1-6.8, respectively), and so had depressed women (age-standardized OR 1.9; 95% CI 1.1-3.4). Women with pain anxiety had a doubled, not statistically significant, elevated risk (age-standardized OR 2.0, 95% CI 0.95-4.3). The groups did not differ significantly in pain intensity or severe pain. Severe pain was predicted by depressed mood and probably linked to gender, age and sick roles.

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Section: Discussionmentioning

confidence: 89%

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Löfvander

Taloyan

2007

Eur Spine J

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“…Several reasons have been cited as to why determining a standardized metric for pain intensity and standardized cutoff points for pain-intensity levels across populations, disease conditions, and instruments is important. First, from a clinical perspective, having standardized pain-intensity measures (mild, moderate, severe) across different tools would help improve clinical decision-making regarding appropriate therapies for pain management; it would also facilitate communication about pain among clinicians and between clinician and patient [25]. Second, from a research perspective, a standardized metric for mild, moderate, and severe pain would provide greater confidence to investigators when comparing outcomes across groups for which different painintensity tools have been used [25].…”

Section: Discussionmentioning

confidence: 99%

“…First, from a clinical perspective, having standardized pain-intensity measures (mild, moderate, severe) across different tools would help improve clinical decision-making regarding appropriate therapies for pain management; it would also facilitate communication about pain among clinicians and between clinician and patient [25]. Second, from a research perspective, a standardized metric for mild, moderate, and severe pain would provide greater confidence to investigators when comparing outcomes across groups for which different painintensity tools have been used [25]. Third, both clinicians and researchers would benefit if demonstrating that categorizations of mild, moderate, and severe pain corresponded reliably and accurately to three distinct ranges of pain severity as measured with the more refined quantitative instruments were possible [20].…”

Section: Discussionmentioning

confidence: 99%

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents

Jones¹,

Vojir

Hutt³

et al. 2007

JRRD

156

111

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Abstract-Older adults in nursing homes experience pain that is often underassessed and undertreated. Visual analog painintensity scales, recommended for widespread use in adults, do not work well in the older adult population. A variety of other tools are in use, including the Verbal Descriptor Scale, the Faces Pain Scale (FPS), and the Numeric Rating Scale. These tools are more acceptable to older adults, but no agreement exists about how to compare the resulting pain-intensity scores across residents. This study examined the equivalency of painintensity scores for 135 nursing home residents who reported their pain on the three different instruments. The results were validated with a second sample of 135 nursing home residents. The pain levels across the three tools were highly correlated, but residents were found to underrate higher pain intensity on the FPS. A modification of scoring for the FPS led to greater agreement across the three tools. The findings have implications for use of these tools for quality improvement and public reporting of pain.

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“…This is particularly so when NRS scores of 3 or lower are considered adequate pain control. 22 Fourteen of the 20 patients had an NRS score of 3 or lower upon ICU admission, 20 of 20 patients after 12 hours, and 17 of 20 patients after 24 hours. The apparent increase in NRS score after 24 hours can be explained by initial mobilization, but it still appears low compared to observations by other groups.…”

Section: Discussionmentioning

confidence: 94%

Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery

Poblete¹,

Konrad²,

Kothbauer

2014

SPI

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Object The aim of this study was to provide evidence for the effect of intrathecal morphine application after spinal cord tumor resection. Methods Twenty patients participated in a prospective open proof-of-concept study. During dural closure, morphine (7 μg/kg) was injected into the subarachnoid space. All patients were monitored in an intensive care setting postoperatively. Pain, additional opioids given, and vital parameters were recorded. Results Six patients received a mean morphine dose of 365 μg between C-3 and C-7 and 14 patients received a mean dose of 436 μg between T-2 and T-12. In the cervical and thoracic groups, the mean Numeric Rating Scale score was highest upon intensive care unit admission (1.2 and 2.5, respectively) and declined at 12 hours (0.5 and 0.8, respectively). Minimal extra morphine was required. Minor side effects occurred without consequence. Conclusions Intrathecal morphine for postoperative analgesia after resection of cervical and thoracic spinal cord tumors is effective and safe. These preliminary results require confirmation by larger comparative studies and further clinical experience.

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Asking the Community About Cutpoints Used to Describe Mild, Moderate, and Severe Pain

Cited by 104 publications

References 17 publications

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents

Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery

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